Matthew T Wiedell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4018 Issued in MN

Practice address

1 3Rd Ave NE
Crosby, MN 56441-1665

Phone

(218) 546-5108

Fax

(218) 546-5736

NPI assigned

Jul 1, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

S Sjoberg PLCGroup PAC ID 0244459824, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: matthew.wiedell.p1@direct.greatrivereyeclinic.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• S Sjoberg PLC

  • Health Service Clinic/Center
  • Crosby, MN
  • NPI 1023424926

  Optometrist

  Medicare reassignment Care Compare group NPD
• S Sjoberg PLC

  • Ophthalmology Physician
  • Baxter, MN
  • NPI 1477961019

  Optometrist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1376432435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7636 Design Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Baxter",
            "state": "MN",
            "postal_code": "564258678",
            "country_code": "US",
            "telephone_number": "218-825-1976",
            "fax_number": "218-546-5736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDELL",
        "first_name": "MATTHEW",
        "middle_name": "T",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-07-01",
        "last_updated": "2025-07-01",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "4018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Kay Taylor, NP-C
• Judith Hilary Weis, MA, RN, CNS
• Jenna Wentzlaff, PHARMD
• Richard L West, O.D.
• Robert Kenneth Westin, MD
• Michael Kendon Wiedell, MD
• Alissa Wigen, PA-C
• Amanda M Wilson, REGISTERED DIETITIAN
• Jamie Withrow, RD,LD,CDE
• Lindsey Anne Wolff, NP-C

• Optometrist in Crosby, MN
• Providers in Crosby, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.